If your doctor has raised concerns about your cholesterol, it’s time to consider a change. Here are five things you need to know to keep your cholesterol in check.
Cholesterol is a lipid, which is a waxy fat-like substance that is naturally produced in the body’s liver and is needed to help build cells and carry out essential functions, explains Mark Benson, MD, director of cardiovascular prevention in Beth Israel Deaconess Medical Center’s CardioVascular Institute. Cholesterol is also found in some foods, like fatty beef, full-fat dairy, and eggs. However, unlike certain vitamins and nutrients, your body doesn’t need cholesterol from external food sources to maintain health.
“When there is too much cholesterol in the bloodstream, it builds up in the walls of arteries and can form plaque, a sticky substance that can prevent oxygen and nutrients from reaching the heart muscle,” says Benson. “In the worst case scenario, the end result could be a heart attack.” Foods that are high in saturated fats and trans fats are the primary reason for this buildup of cholesterol.
“LDL (low-density lipoprotein) is known as ‘bad’ cholesterol because it deposits harmful fat in the blood vessel walls of the heart,” says Benson. “HDL (high-density lipoprotein) is known as the ‘good’ cholesterol because it actually extracts cholesterol from blood vessel walls and transports it back to the liver for disposal.”
But Benson adds that it’s been difficult to show that raising someone’s HDL cholesterol will reduce their risk of having a heart attack. “On the other hand, if you lower LDL cholesterol through lifestyle interventions or medications, many large studies have shown that you can significantly reduce the risk of having a heart attack, suffering stroke, or dying from heart disease,” he says.
Familial hypercholesterolemia is an inherited condition that results in someone having naturally high cholesterol. Benson says that in these cases, LDL readings can be very high, typically over 190 mg/dl. “This is important, because if your genetic wiring is causing high cholesterol, you’ve probably been exposed to high LDL your whole life,” he says. “For people whose LDL levels are not related to genetics, they’ve probably only had high LDL levels since they’ve entered their 40s, 50s, or 60s.”
Doctors would start thinking about digging deeper to determine if there was a genetic factor at play if there’s a strong family history of either high cholesterol or heart disease at a young age, or if a primary relative like a parent or sibling had a heart attack, stroke, or vascular disease, such as peripheral artery disease before age 55 in men or before age 65 in women.
Before prescribing a cholesterol-lowering medication, doctors look carefully at a patient’s cholesterol measurements, as well as family history of cardiovascular disease, blood pressure, age, gender, whether you smoke, and if you have had any prior heart disease. “When we put all of this information together, we can get a fairly accurate sense of a person’s risk of developing heart disease,” says Benson. “And if that risk is high enough, then we would consider starting medications to control cholesterol.
Here are some generally desirable levels to keep in mind:
Total cholesterol: under 200 mg/dl
LDL (bad) cholesterol: under 100 mg/dl
HDL (good) cholesterol: over 60 mg/dl
Triglycerides (the main component of body fat in people): under 150 mg/dl
For more information, visit bidmc.org.
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